Conquering Medial Tibial Stress Syndrome

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Conquering Medial Tibial Stress Syndrome
While runners account for the majority of MTSS cases in sports medicine practices, athletes who participate in any running, jumping or cleated sport may be susceptible to these injuries.
This MRI reveals a non-displaced fracture of the distal tibia. The active 45-year-old female initially complained of six weeks of progressive pain that started at the ankle and radiated up the proximal tibia to the mid-shin. (Photo courtesy of Nicholas Ro
This positive bone scan indicates bilateral tibial stress fractures as well as associated right first metatarsophalangeal joint (MPJ) arthritis.(Photo courtesy of Eric J. Heit, DPM, and Richard T. Bouche, DPM)
By John T. Hester, DPM, MSPT

   Nutritional assessments and diet counseling may be indicated even for athletes without disordered eating. Insufficient protein or calcium intake relative to the caloric demands of the athlete’s specific activity may be present.16

When Athletes Can Return To Activity

   The return to activity for athletes after treatment for MTSS must be gradual and individualized. Athletes must adhere to the “start low and go slow” mantra. Once athletes are asymptomatic, they can typically start at 50 percent of their baseline training load and increase the frequency/intensity/duration by 10 to 15 percent per week. They should avoid back-to-back days of repetitive impact activity for the first two to four weeks, depending on the severity of the case.

   If symptoms recur, two additional weeks of rest are recommended and should be followed by a “downgraded” training regimen. Patients can often achieve a return to full, unrestricted activity in three to six weeks. However, a delayed return is not uncommon for this often refractory condition.

Dr. Hester is a Fellow of the American College of Foot and Ankle Surgeons. He is in private practice with Sports Medicine Associates and Pro Sports Orthopedics, and is the team podiatrist for the Boston Celtics.


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Anonymoussays: July 22, 2010 at 12:35 pm

Excellent Resource. Offers great clarity for this often misdiagnosed malady.

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Anonymoussays: September 17, 2010 at 3:23 pm

very good article.

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Anonymoussays: January 6, 2011 at 2:15 pm

Yes, this was a very good article. Very informative. Thank you.

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